The cookies in the experimental phase of their development were distributed to 30 elderly people, in the Geriatric ward of Nice University Hospital.

 This study aimed:

- To determine whether this new Oral Nutritional Supplement (ONS) was enjoyed by sick, malnourished or at risk of malnutrition elderly;

- To determine the best time (meals or snacks) to eat the cookies; and

- To estimate the impact of cookie consumtion on oral and dental health.

 

The inclusion criteria for this study were: age > 70, and ability to eat without assistance solid, chopped, or mashed food, without swallowing problems.

The small butter cookies were made by the hospital Pastry Chef. Each cookie weighed 5 g and contained 1g of milk protein and 29 kcal with 21% of the total energy from protein. During the one week experiment, each participant was given a box of 7 cookies (35 g) every morning.

The experiment took place from February 1 to April 30, 2009. The average age of the 30 patients was 83 years old, 11 men and 19 women.

Among the 30 patients who took part in the experiment, 77% had protein-rich milk drinks, milk creams or protein fruit juices in the morning at 10am. The intake of these nutritional complements had no impacton the cookie intake.

The satisfaction questionnaire that was given to the patients about the cookies focused on the acceptability and the sensory properties of this new product.(evaluation - -, -, 0, +, + +), with the possibility for comments.

Acceptability

• 52% of the patients ate the cookies with a drink, usually water.
• 75% of the patients considered the cookies "good" or "very good".
• Women liked the cookies more than men (p<0,05).

 

Sensory properties of the cookies

- Look: the patients gave the cookies an average mark of 3,9/5. Comments like "cute, small" were mentioned several times.

- Taste: the patients gave an average mark of 3,9/5. Women liked the taste of the cookies much more than men (p<0,01). Comments: " They have a nice taste of butter", "It is just like the good old-fashioned cookies", "We do not experience the taste of the proteins", "They do not have a strong taste of milk".

- No aftertaste: this specific aspect of the protein cookies was particularly appreciated, with an average mark of 4,5/5.

- Ease to swallow the cookies: this aspect was also very much appreciated, with an average mark of 4,3/5. Comments : "It goes down well", "I do not struggle to swallow them", "These cookies are not big so it goes down quickly, which is good for me".

- "In the stomach": the cookies are easy to digest, with an average mark of 4,5/5. Comments : "It goes well", "I digest them well despite my stomach problems. It is very light and it does not swell up like bread".

This study showed that preferred intake times vary significantly:

• 40% prefer to have them regularly during the day,
• 40% prefer to have them for the afternoon snack (16h),
• 20 % prefer to have them for the morning snack (10h).

The oral parameters did not have an impact on the cookie intake: the cookies were eaten and appreciated by patients without oral problems as much as by patients suffering from oral pain (3%),drymouth (21%), lack of teeth (50%), with removable dentures (30%) or needing new dentures (50%).

Results synopsis

1. In this group of 30 elderly people staying at the hospital, 75 % of the patients liked the high-protein, high-energy cookies, despite the fact that these people represent a group of patients with a high risk of anorexia.

2. This study has highlighted the notion of pleasure to have the cookies whenever one wishes, without imposed times. The fact that the boxes contained a number of portions allowed the patient to deal with the snack himself when it best suited him.

3. Approximately half of the patients (52%) took the opportunity of "the cookie break" to drink water, which encouraged them to drink more fluids.

4. Women like the cookies more than men.

5. The cookie intake is not related to the intake of liquid nutritional complements.

6. Whatever the dry mouth or dental or denture problems, the acceptance of the cookies remains the same: the intake is based on the notion of pleasure.

Conclusion

The pleasure of eating is essential to fight anorexia and weight loss in diseased and elderly patients. Taste, texture and acceptability of this solid dietary supplement were appreciated by 30 hospitalized elderly patients in Nice University Hospital (France). In order to improve palatability, to please the tastes of the elderly and to comply with environmental concern, cookies were made with fresh butter without vegetable oils (no palm oil). The butter-containing formulation increases elderly appetence for Protibis cookies. It should be noted that fresh butter is allowed because restrictive diets (no-cholesterol diets) are not recommended for malnourished people (Zeanandin and coll ., on 2012).